Posted By Electa Draper On April 9, 2014 @ 7:58 am In General Medicine,Health Care Policies,Medical research | No Comments

Exempla Saint Joseph Hospital’s Mobile Mammography Van during a visit to the State Capitol. The Mobile Mammography Van is funded in part by a grant from the Susan G. Komen for the Cure Denver Affiliate and the Safeway Foundation. (The Denver Post files)

Dr. John Lewin, the Rose Breast Center medical director, says the new “controversy” over whether the benefits of mammography screening for breast cancer is overblown by the media and not based on new evidence, but rather follow-ups and re-examination of 50 years of old clinical trials.

A review published April 2 in the Journal of the American Medical Association, adds to the uncertainty of recent years over the value and risks of mammography.

The U.S. Preventive Services Task Force (USPSTF) triggered furor over mammography when it changed its recommendations in 2009 — from advising women to have a mammogram every one to years starting at age 40 to now advising that screening begin at age 50 and be done every two years.

Yet the American Cancer Society did not change its recommendation and still advocates a yearly mammogram beginning at age 40.

“The interesting thing about all this is that it is so driven by the media,” Lewin said.

There is no new research, Lewin said, but old clinical trial, some of which, especially the most recent Canadian trial, had serious problems in terms of the way they were conducted.

The JAMA article and others in recent years, all based on eight clinical trials done since the 1960s, indicate that mammograms can save lives, Lewin said, but the benefits are smaller for women in their 40s, reducing the risk of death from breast cancer by about 19 percent, he said. Other reports indicated the reduction in mortality is an average of 15 percent for the 40-year-olds.

“There is still a benefit,” Lewin said.

Co-author of the JAMA article, Dr. Nancy Keating of Harvard Medical School, warned that the small benefit has to be weighed against the risks of screening, including “overdiagnosis,” when women with tumors that never would have been life-threatening endure unnecessary surgery, chemotherapy and radiation.

“When you go looking for cancer, … you are going to find a certain number of cancers — an estimated one in five — that would never have killed anybody,” Lewin said. “But the majority of us in radiology still (focus) on the fact that mammography cuts down on breast cancer deaths.”

For women in their 60s, the reduction in breast cancer mortality is close to 30 percent, Lewin said.

And the risks of mammography radiation, he said, are virtually nonexistent for those 40 and older, although there is data that it can cause breast cancer in girls and very young women. It does not harm women in their 40s and 50s, he said (although there is less data about women in their 30s).

Nothing really has changed, despite all the new headlines, Lewin said — mammography saves lives.